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1 Running Head: ALCOHOL MISUSE AMONG COLLEGE STUDENTS 1 Examining Alcohol Use and Misuse among College Students: A Comprehensive Review Natalie E. Chase Illinois State University Natalie E. Chase, Department of Psychology, Illinois State University Correspondence concerning this review should be addressed to Natalie E. Chase, 400 Kingsley St. Apt. #10, Normal, IL

2 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 2 Abstract Alcohol use among college students is prevalent. While many students may view drinking as a normal part of a social life during college, alcohol use can get quickly out of hand and result in various alcohol-related problems. The following paper is a review of the existing research literature on the topic of alcohol use and misuse among college students. This review will cover six important sections that may aid counselors in their work with this population. The six sections include: foundations of behavior, assessment, treatment, cultural considerations, ethical considerations, and future research.

3 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 3 Introduction Drinking and college students are two terms that seem to go hand in hand. While it is a myth that all college students drink and drink heavily, researchers have found that a large portion of college students partake in binge drinking (four or more drinks in a sitting for women, five or more drinks in a sitting for men). In fact, according to the College Alcohol Survey (CAS) which was conducted by Harvard University over an 8-year span, about two in five college students (44%) at 4-year universities binge drink. The CAS results showed that this level of binge drinking remained stable in all four research studies that they administered to college students between 1993 and In addition, the findings of the CAS supported several other major research projects that showed similar results (Wechsler & Nelson, 2008). At times, the heavy drinking of college students becomes clinically significant. A study that included over 14,000 students from over 100 four-year universities found that 31% of the students met criteria for a DSM-IV diagnosis of alcohol abuse and 6% met criteria for a DSM-IV diagnosis of alcohol dependence. Results also clearly showed that there is a connection between heavy episodic drinking and abuse or dependence as students who reported frequent binge drinking were 13 times more likely than non-binge drinkers to meet criteria for abuse and 19 times more likely to meet criteria for dependence (Knight, 2002). Alcohol use among college students is not an issue that can be ignored. Much attention has been paid to this topic in the research literature. The following paper will attempt to review the literature in five categories related to college students and alcohol use. The first section will examine the foundations of drinking behavior among college students. More specifically, two subgroups with high alcohol usage will be examined as well as a theory that explains how and why college students may drink. The next section reviews the assessment process when working

4 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 4 with students with alcohol-related problems. The third section covers the literature on alcohol prevention programs for college students as well as various treatments that can be used with this population. Next, cultural consideration will be discussed. This section will examine how culture plays a role in the assessment phase, the treatment phase, and the therapeutic relationship. Suggestions will be given for effective work with particular diverse populations. Finally, the last section of the literature review includes ethical considerations when working with college students with alcohol-related problems. Various ethical dilemmas will be discussed. The paper will conclude with a section on suggestions for future research in each of the five sections previously mentioned. Foundations of Behavior The following section examines possible reasons that a college student would engage in heavy drinking behaviors. The section includes a discussion of the environmental factors that may contribute to alcohol use as well as individual factors that may influence drinking. However, before looking at these specific factors associated with heavy drinking among college students, it is important to consider the general question of, Why do people drink problematically? Research indicates that people drink heavily for many reasons. However, one of the main reasons is to cope with life stressors. The correlation between use of alcohol and coping with distress and other negative emotions is well established in the literature (Buchmann et al., 2010; Howell, Leyro, Hogan, Buckner, & Zvolensky, 2010; Ohannessian et al., 2010). People may use alcohol as a coping strategy to escape their problems, relieve stress and pressure, forget their loneliness, or boost their self-confidence. Within the overall idea that alcohol is used as a coping strategy, some individuals may also use alcohol specifically to self-medicate and relieve symptoms of depression, anxiety, or other disorders (Dixon, Leen-Feldner, Ham, Feldner,

5 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 5 & Lewis, 2009; Gonzalez, Bradizza, & Collins, 2009). Using this general knowledge about reasons for heavy drinking may be useful in explaining why certain college students drink problematically. The remainder of this section will now focus on specific contexts or factors that may influence problematic drinking among college students. However, it is important to keep in mind these general, underlying explanations when considering the specific explanations for why college students engage in problematic drinking behaviors. Social Environment College campuses are unique social environments that allow students particular social experiences unavailable during other times in life. Many of these experiences involve being part of close-knit groups that typically are made up of very homogeneous populations. Students may come into these groups with shared values and ideas, or their values and ideas may be molded once a part of the group. Either way, research has often indicated that two groups in particular, student athletes and students involved in sororities or fraternities, have much higher rates of risky alcohol behavior (binge drinking or high frequency of drinking) than the typical college student (Ford, 2007; Hildebrand, Johnson, & Bogle, 2001; Park, Sher, & Krull, 2008; Wechsler, Kuo, Lee, & Dowdall, 2000), suggesting that the social environment may be a contributing factor to alcohol use. Much of the following research supports this idea that social influence contributes to alcohol use; however, there is some evidence to the contrary. The majority of this section will examine the research involving risky alcohol behavior among college athletes and members of a Greek organization. The end of this section will look at the effects of living situation on alcohol consumption. College athletes. Numerous researchers have found that both male and female college athletes are more likely to be involved in risky alcohol behaviors than male and female college

6 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 6 student who are not athletes (Ford, 2007; Hildebrand et al., 2001; Leichliter, Meilman, Presley, & Cashin, 1998; Nattiv & Puffer, 1991; Nelson &Wechsler, 2001; Wechsler, Davenport, Dowdall, & Grossman, 1997; Wilson, Pritchard, & Schaffer, 2004). More specifically, athletes were found to drink alcohol more frequently than non-athletes (Hildebrand et al., 2001; Wilson et al., 2004). Hildebrand et al. (2001) found that 39% of athletes drank two or more times per week compared to only 21% of non-athletes. Numerous researchers have also found that athletes tend to consume more drinks per sitting than do non-athletes and consume more alcohol per week than non-athletes (Hildebrand et al., 2001; Leichliter et al., 1998; Nattiv & Puffer, 1991; Nelson &Wechsler, 2001; Wilson et al., 2004). Over 62% of athletes average three or more alcoholic beverages per sitting compared to only 44% of non-athletes (Hildebrand et al., 2001). Viewed in a different way, athletes consumed an average of 5.35 drinks per sitting compared to only 2.45 drinks per sitting for non-athletes (Wilson et al., 2004). Male athletes average about 10 drinks per week compared to only six for male non-athletes. Female athletes average a little less than five drinks per week compared to only about three drinks for female non-athletes (Leichliter et al., 1998). Looking further into the subgroup of athletes, it appears that athletes who are in a leadership role on their teams consume more alcohol per week than their teammates who are not in leadership positions (Leichliter et al., 1998). Even more problematic, athletes are more likely to binge drink than non-athletes and also binge drink more frequently than non-athletes (Ford, 2007; Hildebrand et al., 2001; Leichliter et al., 1998; Nelson &Wechsler, 2001; Wechsler et al., 1997; Wilson et al., 2004). Almost half of the non-athlete population reported no binge drinking compared to only a little over a quarter of the athlete population. In addtion, 42% of athletes reported binge drinking a few times a month while only 27% of non-athletes reported this statistic (Hildebrand et al., 2001).

7 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 7 So what is it about athletes that make them more likely to participate in risky alcohol behaviors? One explanation may be athletes level of social influence (Nelson &Wechsler, 2001; Ford, 2007). Many college athletes likely belong to a peer intensive environment. While all college students are in a social environment surrounded by peers, athletes tend to be in a social environment that involves the same group of peers every day and at every social encounter with little exception. They spend the majority of their time with their teammates or with other athletes. This likely leads to less time with other students and isolation from the general student body. In a peer intensive environment, people are more likely to be influenced by group norms (Ford, 2007). Looking more specifically at levels of social influence, athletes were more likely to report having five or more close friends than non-athletes. In addition, athletes reported that the majority of their friends were binge drinkers. Athletes reported spending more time throughout the week socializing with friends, on average at least two hours per day, than did non-athletes. (Ford, 2007; Nelson &Wechsler, 2001). In summary, the combination of having more friends, having more friends who are heavy drinkers, and spending more time socializing with these friends may influence the level of alcohol consumption seen in college athletes, especially if athletes find themselves isolated in peer intensive social groups with other athletes. I speculate that many college athletes feel the need to fit in with their teammates and that this promotes heavy drinking. This may be particularly relevant in sports that are considered team sports such as soccer, basketball, football, and softball. Team sports are designed around the concepts that the team comes before the individual and all team members must work together to reach a common goal. These same concepts may transfer over to social situations when teammates who do not desire to drink feel the need to in order to fit team concepts. I also

8 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 8 speculate that peer pressure is a major contributing factor to drinking behaviors among college athletes. Although no empirical evidence was found supporting the connection between alcohol use, college athletes, and peer pressure, I believe that male athletes may experience more overt peer pressure from their teammates and female athletes are more likely to experience subtle peer pressure from teammates. Members of a Greek organization. Student who are affiliated with the Greek system are more likely to drink than students who were not affiliated with Greek life (Ford, 2007; Champion et al., 2009; Dorsey, Scherer, & Real, 1999; Park et al., 2008; Kahler, Read, Wood, & Palfai, 2003; Neighbors, Lee, Lewis, Fossos, & Larimer, 2007; Theall et al., 2009; Wechsler et al., 2000). In a survey of 239 college students, 84 of whom belonged to a fraternity or sorority, over half (54%) of students who reported drinking in excess or binge drinking within the previous two weeks were Greek members (even though they made up only 35% of the population surveyed) compared to only 46% being non-greek members (65% of the population surveyed). More strikingly, out of the students who reported no binge drinking within the previous two weeks, 86% were non-greek members leaving Greek members at only 14% (Dorsey et al., 1999). In another study, Park et al. (2008) found that alcohol use changed as status in a Greek organization changed. More specifically, participants completed a survey asking questions about several different factors including alcohol use and Greek affiliation. Students took these surveys twice, with approximately 2.5 years separating the two survey times. Participants were classified into one of four Greek statuses; constant non-greek members, constant Greek members, late joiners (non-greek to Greek), and droppers (Greek to non-greek). Looking at results from the first survey, initial Greek members (constant Greeks and droppers) had higher rates of alcohol use and heavy alcohol use than initial non-greeks members (constant non-greeks and late

9 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 9 joiners). Results from the second survey indicated that constant Greeks increased levels of heavy drinking more than constant non-greeks. Students who had dropped out of their fraternity or sorority by the second survey decreased heavy drinking levels more than constant Greek members. Students who joined a Greek organization during the two and half years in between the surveys increased heavy drinking rates more than constant non-greeks. Overall, drinking levels correlated with Greek status even when Greek status fluctuated over time. Viewing sororities and fraternities as cohesive social networks is another way to explain heavy drinking among this population (Dorsey et al., 1999). A cohesive social network is one in which members have a high level of direct communication among themselves. Other characteristics include having common norms and expectations, models of normal behavior, rewards for acting within the norms, strong ties, and minimized diversity. Considering Greek organizations as cohesive social networks may explain why most members of these organizations would conform to the norms of the network, in this case engaging in binge drinking or other risky drinking behaviors. While Greek members tend to drink and binge drink more than other college students, not all Greek members participate in heavy drinking. How can the different levels of binge drinking among Greek members be explained? One explanation may be levels of self-consciousness (Park, Sher, & Krull, 2006). Self-consciousness is defined as attending to certain aspects of the self (Park et al., 2006, p.85). Private self-consciousness refers to personal aspects including attitudes, motives and feelings, whereas public self-consciousness refers to observable aspects such as behavior and appearance. People who are high in private self-consciousness are more accurate about their own affect and behaviors due to intense introspection. On the other hand, people who are high in public self-consciousness focus on themselves from a social perspective

10 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 10 and are constantly comparing themselves to social expectations. Therefore, those with high public self-consciousness are more likely to be influenced by social pressure than both people with low public self-consciousness and people with high private self-consciousness. Considering this information in the context of Greek members and alcohol consumption, self-consciousness appears to be a factor in Greek members level of binge drinking (Park et al., 2006); however, it affects men and women differently. More specifically, fraternity members with high public and private self-consciousness engaged in less binge drinking than fraternity members with low public or private self-consciousness. Fraternity members who are high in both types of self-consciousness likely act according to certain internal and external standards. These standards often inhibit impulsive or maladaptive social behaviors such as getting excessively drunk. On the other hand, those who are low in public self-consciousness are likely not concerned with others opinions of their heavy drinking. High private self-consciousness had an opposite effect on sorority members as it increased likelihood of binge drinking. Based on this finding, Park et al. hypothesized that female Greek members with high private selfconsciousness may use drinking as a coping strategy to avoid internal reflection which may lead to negative self-evaluation. Researchers have found that actual membership in a fraternity is not necessary to influence drinking behaviors, but merely the intent of joining may be influential (Read, Wood, Davidoff, McLacken, & Campbell, 2002). Incoming male students with intent to join a fraternity showed higher alcohol consumption than incoming male students who did not intend to join a fraternity. Similar results were not found with women. This finding brings up the question about whether students who are heavier drinkers join Greek organizations, if joining a Greek organization leads to heavier drinking, or both.

11 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 11 O Connor, Cooper, and Thiel (1996) found evidence supporting the first notion. Men who entered college with a history of high alcohol consumption in high school were found to pledge fraternities in a much higher proportion than men with histories of low or moderate alcohol consumption. Perhaps it is the perceptions of a heavy drinking environment that attract heavy high school drinkers to join a fraternity. Perceptions about drinking and social norms will be discussed in the following section. Similar to college athletes, I believe a major contributing factor to heavy drinking among members of a Greek organization is peer pressure. Pledges may feel pressured to drink in order to fit in with current members, and current members may feel pressured to drink to meet the perceived social norms of drinking within the organization. I believe many Greek members feel the need to drink because that is what they are supposed to do as members of a sorority or fraternity. In addition, I speculate that many prospective members or current members have learned drinking behaviors through observational learning. Many college students likely get a chance to observe or hear stories about fraternity parties or initiation ceremonies around campus. However, no research was found to support the connection between Greek membership, alcohol use, and observational learning. Living situation. A final social factor to consider is living situation. Researchers have found that living environment effects drinking behaviors. Students with more supervision in their living environments, such as living at home or a residence hall, were less likely to binge drink than those with little or no supervision in their living environments, such as a Greek house or off-campus (Champion et al., 2009; Wechsler & Nelson, 2008). In addition, for those students living on campus in a residence hall, those who lived in a substance-free setting were less likely to drink than those living in a hall that allowed some alcohol (Champion et al., 2009). Students

12 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 12 with roommates reported higher levels of alcohol consumption than those who lived alone (Theall et al., 2009). I speculate that students with little or no supervision in their living environments likely drink more because they are more easily able to keep alcohol in their rooms, houses, or apartments. With more alcohol readily available, drinking becomes a realistic option at almost any point throughout the week. In addition, higher drinking rates are likely found in this population either because there are no policies against drinking or because there is a lower threat of being caught breaking policies and having to endure the subsequent punishment. Students living in supervised dorms or at home likely have rules about drinking that are supposed to be followed. In addition, the thought of facing punishment if the rules are broken is likely to be a deterrent for some supervised students. Individual Factors On the opposite end of the spectrum from social influence, individual factors contribute to the tendencies to drink among college students. While social influences refer to aspects outside of the person, individual factors refer to aspects within the person. The majority of the following section will examine the effects of individual beliefs on alcohol use. The section will begin with discussion on the Theory of Planned Behavior. Researchers working on this theory attempt to explain factors that contribute to behavior. Next, components of the Theory of Planned Behavior will be examined as they relate to alcohol use among college students. Research on social and peer norms as well as attitudes about drinking will be examined. The Theory of Planned Behavior. The Theory of Planned Behavior is a theory that explains causes of behavior. Applied research has shown that there is a correlation between particular beliefs about social and peer norms and drinking behavior, but the theory of planned

13 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 13 behavior can more thoroughly indicate how these beliefs, along with other variables, combine to explain such a big part of actual behavior. As reviewed by Azjen (1991), the Theory of Planned Behavior states that behavioral intentions and perceived behavioral control account for a large portion of variance in actual behavior and can be used directly to predict accomplishing a particular behavior. The concept of behavioral intentions highlights motivational factors that lead the individual to perform a certain behavior. In other words, intentions are indicators of how hard people are willing to try, of how much of an effort they are planning to exert, in order to perform the behavior (Azjen, 1991, p. 3). There are three factors that predict one s intention to engage in a behavior: attitude toward the behavior, subjective norms, and perceived behavioral control. Attitude toward the behavior refers to the degree to which a person has a favorable or unfavorable evaluation or appraisal of the behavior in question (Azjen, 1991, p. 10). Subjective norm refers to the perceived social pressure to perform or not to perform the behavior (Ajzen, 1991, p.10). Perceived behavioral control is an individual s perception of the level of difficulty of performing a particular behavior. Not only is perceived behavioral control a direct factor that influences behavior, but it is an indirect factor that influences behavior through intention. The stronger the intention to perform the behavior the more likely it is to occur as long as the added factor of control over the behavior is also met. In other words, in addition to perceived behavioral control, the individual must also have the ability to decide whether or not to perform the behavior, have opportunities to perform the behavior, and have the resources needed, such as time and money, to perform the behavior. These factors make up actual behavioral control. However, it is the concept of perceived behavioral control, not actual behavioral control, that is

14 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 14 one of the main aspects in the theory of planned behavior and will be discussed further in the next section. Perceived behavioral control is similar to the idea of self-efficacy which states that an individual s behavior is largely dictated by one s confidence in his or her ability to perform a behavior. This type of perceived control usually varies across situations. The prediction of behavior made from perceived behavioral control is strengthened if perceived behavioral control realistically reflects actual control. Collins and Carey (2007) set out to test the Theory of Planned Behavior as it applied to binge drinking among college students. They predicted that past binge drinking, drinking attitudes, subjective (social) norms, and drink refusal self-efficacy would predict intent, and as the theory demonstrates, intent would predict future binge drinking behavior. Tests indicated good fit between the theory and the results with a few exceptions. Contrary to the Theory of Planned Behavior, the results indicated that subjective norms did not predict intent. In addition, the model that included intention and past binge drinking to predict future binge drinking was a good fit; however, the model that did not include past binge drinking was a better fit. In theory, subjective norms and past binge drinking make perfect sense as predictors of future binge drinking, yet this was not reflected in the research. Perhaps the Theory of Planned Behavior would better predict actual drinking among college students with a few alterations. On the other hand, more research and support is needed to make the proposed changes. The following section examines research on two of the main aspects that predict behavior according to the Theory of Planned Behavior. Subjective norms and attitudes will be discussed, and support for their role in predicting drinking among college students will be examined.

15 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 15 Perceived social and peer norms (subjective norms).while actual levels of alcohol consumption among peers appear to influence drinking behaviors for certain college groups as mentioned previously, another major reason cited for heavy drinking among college students is their misperceptions about drinking norms among their peers (Larimer, Turner, Mallett, & Geisner, 2004; Perkins, Meilman, Leichliter, Cashin, & Presley, 1999; Theall et al., 2009). In other words, many college students overestimate the amount and frequency that other students are drinking (descriptive norm), and this may lead them to drink more themselves. The latter part of this hypothesis can be found in elements of Bandura s (1986) social learning theory as well as the social comparison theory (Festinger, 1954). More specifically, people compare themselves to others in order to determine their own opinions and abilities (Festinger, 1954). In addition, according to Bandura (1986), people do the majority of their learning through observing the actions and attitudes of other people and then modeling this behavior. If college students not only compare themselves to other students in terms of drinking behaviors but also misperceive what they are observing, their drinking behavior is likely going to imitate how they believe other students are behaving. Social comparison as well as the need to imitate others behavior could understandably cause a sense of social pressure to behave in a certain way. The Theory of Planned Behavior states that if students feel social pressure to behave in a particular way they will have a stronger intention to perform the given behavior, in this case drinking. In other words, according to the Theory of Planned Behavior (Azjen, 1991), it is the social pressure felt from the subjective norms that influences intent to perform the behavior. Let us take a look at some of the research that supports subjective norms as a predictor of alcohol consumption among college students.

16 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 16 There is empirical evidence that indicates that college students do overestimate alcohol usage norms (Perkins et al., 1999). For example, when students from 100 different colleges with varying levels of average alcohol use were asked to predict alcohol use (no use, yearly use, monthly use, weekly use, or daily use) for the average student on their respective campuses, only 28% of students were able to predict this statistic accurately. Only 3% of students underestimated the amount of alcohol consumed by the average college student, whereas 69% of students overestimate the norm. Even on campuses where the average student drank on a weekly basis, 22% of students still overestimated the norm and believed that the average student drank on a daily basis. One reason that college students may overestimate alcohol norms among their peers is the idea that students might more quickly and vividly recall times of high exuberance and drinking atmospheres than times that are calm and alcohol-free (Perkins et al., 1999). Therefore, social settings involving alcohol use get a disproportionate amount of attention from students and the media compared with daily activities in the life of a college student. This disproportionate amount of attention may explain the overestimation of alcohol usage norms by college students and the media. Once these overestimations occur, Lewis and Clemens (2008) found that there is a correlation between perceived alcohol use of others and one s own consumption of alcohol. Students were specifically asked to estimate the amount and frequency of alcohol use among their closest same-sex friend and closest opposite-sex friends. Results indicated that there was a significant positive correlation between perceived alcohol use intensity of the closest oppositesex friend and alcohol use intensity for the respondent. In addition, there was a highly significant positive correlation between perceived alcohol usage intensity of the closest same-sex

17 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 17 friend and alcohol use intensity for the respondent. While this study did not examine perceived social norms because the respondents were only asked to estimate drinking behaviors of two close friends, results indicate that perceptions of behaviors of closest friends may account for the largest percentage of variance that accounts for actual drinking behaviors. While perceived social norms is an important factor, perceived norms of close friends, rather than a large social group, may be more important. In addition, I speculate that perceived norms of close friends likely puts more social pressure on students than perceived social norms of the larger student population. As mentioned earlier, it seems that social pressure may be the mediating factor between perceived norms and drinking behavior. Another contributor of drinking behavior is a type of subjective norm called an injunctive norm. In terms of alcohol consumption among college students, an injunctive norm would be the perceived acceptability of drinking among a particular social group (Colby, Colby & Raymond, 2009; Larimer et al., 2004). Injunctive norms fall under the umbrella of subjective norms and combine with attitude and perceived behavioral control within the Theory of Planned Behavior (Azjen, 1991) to help predict behavioral intent and behavior. When considering both descriptive norms and injunctive norms within a college population, it has been found that not only do both types of norms influence drinking (Larimer et al., 2004) but that these social norms are one of the best predictors of alcohol use among college students (Neighbors et al., 2007). In a study that examined multiple predictors of drinking including demographics such as gender and Greek affiliation, social norms, motives, and expectancies, most of the variance was associated with perceived descriptive norms and perceived injunctive norms (Neighbors et al., 2007).

18 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 18 When looking at a specific college population, members of a Greek organization, Larimer et al. (2004) found that descriptive norms, in this case perceived drinking among other members of the fraternity or sorority, helped to predict current drinking behaviors. On the other hand, students perceptions of injunctive norms, in this case acceptability of drinking within their respective fraternity or sorority, helped to predict drinking behaviors one year in the future. While much of the literature indicates that perceived social and peer norms are the main contributors to problem drinking among college students, there is some evidence to show that attitudes, one of the other elements from the Theory of Planned Behavior, also contribute to alcohol consumption among college students. Attitudes are described in the next section. Attitudes. Ford et al. (2007) examined one particular high-risk college subgroup, athletes, and found that students whose beliefs are more accepting of drinking alcohol and binge drinking were more likely to actually binge drink. More specifically, some of these beliefs included believing that parties are an important part of college social life (Ford, 2007; Nelson & Wechsler, 2001) and believing that the legal drinking age should be lowered (Ford, 2007). Burden and Maisto (2000) examined the effects of attitudes and expectancies on college student drinking behaviors. Attitudes towards drinking were defined as the evaluation, either good or bad, of performing drinking behaviors. Expectancies of drinking were defined as the likelihood of an event occurring due to drinking behaviors. Results indicated that attitudes towards drinking accounted for a large proportion of the variance in drinking behaviors once demographic variables and social norms and attitudes towards college life were taken into account. In addition, the evaluation, good or bad, of outcome expectancies of drinking accounted for a large proportion of the variance in the level of alcohol usage. However, overall

19 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 19 it was found that attitudes towards drinking were more important than expectancies in predicting alcohol consumption. Wilson et al. (2004) found evidence to support this link between beliefs in alcohol as a coping mechanism and alcohol consumption. Students who reported using alcohol as a way to feel better consumed more alcohol and drank more frequently than students who did not report this as a reason for drinking. This result was found for all groups of students in the study except for male athletes. Other coping methods used by some groups of students that were found to be associated with higher frequency of drinking included to get through a problem or for venting. This link between beliefs in alcohol as a coping strategy and alcohol consumption suggests that students who have trouble regulating their negative moods might be more at risk for drinking. There is an empirical reason to believe this is true. Kassel, Jackson, and Unrod (1999) investigated the relationship between Negative Mood Regulation (NMR) expectancies and problem drinking. NMR was defined as positive expectations of one s ability to handle and manage negative affect. After accounting for factors such as age, gender, alcohol consumption, and affective distress, a strong negative correlation was found between NMR and problem drinking behaviors. As expectations of one s ability to cope with negative affect increase, problem drinking behaviors decreases. Perceived behavioral control is one of the major aspects of the theory of planned behavior; however, an exhaustive search for research supporting the link between perceived behavioral control and alcohol use among college students resulted in no findings.

20 ALCOHOL MISUSE AMONG COLLEGE STUDENTS 20 Assessment Assessment is an important component of the overall treatment of alcohol use problems with college students. Accurate and reliable assessment is needed so that therapists can fully understand the problems of their clients. Once an assessment has taken place, and the therapist has a solid understanding of the student s problem, the therapist can then consider the next course of action for treatment. However, without good assessment tools, the process is halted and the student may never receive adequate treatment. The following section includes information on four assessment tools used when working with clients who potentially have issues with alcohol. Each tool will be explained in detail, and empirical support will be included. However, before discussing specific assessment tools, it is important to focus on diagnostic criteria for alcohol use disorders. Diagnosis Assessments are typically conducted to determine if a client exhibits enough criteria of a disorder to be diagnosed. Other times, assessment may be done to examine risky behaviors or patterns of use that could eventually lead to a full-blown disorder. Regardless of the severity of the problem, it is important that therapists understand the diagnostic criteria that are being assessed. Understanding these criteria will help therapists not only better understand the tools they are using, but also better understand symptoms and signs they are looking for in their clients. It is important to note that many assessment tools do not comprehensively measure all criteria under the categories of Alcohol Dependence and Alcohol Abuse in the DSM-IV-TR (American Psychiatric Association, 2000). Many tools are used to examine some of the criteria of dependence and abuse such as patterns of use or problems related to drinking. The diagnostic criteria in the DSM-IV-TR for alcohol dependence and alcohol abuse are included here:

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